THE, diet, like all other parts of the treatment, must have reference to the present condition of the patient. If the disease take the bronchial .1orm, and rapid breathing, and other conditions calculated to carry fat out of the system have not yet supervened; or if the patient have thirst and hectic, the diet must be spare and simple, consisting chiefly of milk and farinaceous substances.
But in all cases where the disease is tubercular, or, being bronchial, has reached the stage of emaciation, the very earliest moment at which the fever can be subdued should be improved to build up the patient with a generous diet. I have seen cases where the stuffing sometimes resorted to for fattening turkeys for Thanksgiving would seem to be almost justifiable. A good rule is to give the most generous diet that can be taken without disturbing the stomach, or increasing the feverish symptoms. , Animal food with a good quantity of salt should be freely taken. Fat meats, if well received by the stomach (and they generally are if taken cold), are particularly useful. The same is true of sweet butter and cream.
Out Door Exercise. Without exercise, as a general thing, the consumptive patient will die. Exercise involves muscular exertion, which is attended by the tension, compressior4 and greater compact~ ness of the muscles used. Extend your walk a little every day. Stretch it out to the distant fields. Gather flowers from the top of the hills and from the bosom of the valleys, and bring them home as trophies of your victory.
If not able to begin with walking, ride as often as possible in a carriage. The jolting of a vehicle will jog the blood along much better than no exercise.
Horseback riding is still better. It combines, in some measure, the passive exercise of carriage riding, with the active exertion of walking on toot.
If the person who has only a small portion of the lung affected and whose general health and strength has not failed, the employment of this advice for exercise cannot be too strongly put forth, as it means the continual inhalation of pure air, caused by the exercise, but I would not have a patient who has perhaps been greatly affected by the disease, think that the way is not open to him for improvement. He will of course not be able to exercise so strenuously, in fact, perhaps the majority of cases do not require as much exercise as has been advocated, provided however, they are placed in a position where an abundance of fresh air is also available and no symptoms appear which show that the strength is being called upon too vigorously, such as the patient being unable to sleep at night and digestive disturbances occur. But to the cases more advanced in the disease, it should be remembered that exercise will do more harm than good and the whole question will be an individual one as no general rules can be laid down for the patient. For as many hours and days as is possible, the patient should be exposed to the direct rays of the sun and protected from high winds. This may be attained on a high elevation, such as the roof of the house, with a southerly exposure.
If it is so the patient can travel, some high, dry climate about 4000 feet in elevation is the best place, and in selecting this resort the thing to be considered is the number of hours of the sunshine he or she win be able to be subjected to. We do not consider now the degrees of temperature, if the climate is free from moisture, as the patient can be properly clothed and be allowed to remain out of doors all day. The high altitude recommended is also beneficial because the patient is obliged to take deep breaths, thus being obliged to exercise his lungs.
Colorado and certain parts of Arizona and New Mexico in the United States, portions of Switzerland which have an elevation of four to five thousand feet above sea level, and San Moritz, abroad, are examples of suitable places.
Before leaving the subject, and for the encouragement of those affected, from the latest statistics at command, sixty per cent. of early cases have been discharged well from the Adirondacks Cottage Sanitarium.
Trudeau, the eminent authority of the United States, reports that one third of all the cases under his observation during the past seventeen years are well and that two thirds of the earlier cases are cured at the present time. Thirty years ago physicians thought that only two per cent. of the cases were curable.
Sea voyages are now not recommended, with the dampness naturally attending the trip, the lack of comfort on the steamer, the short length of time consumed by the trip, its compulsory confinement and the inability to eat nourishing food, if seasickness is present, all weigh against this treatment; in fact, from what has been said, if common sense is used a great improvement can be expected at, or within a reasonable distance of, the patient's home.
Numerous other modes of exercise may be resorted to with advantage. Dumb bells, adapted in size to the strength of the patient, and used with caution, are highly serviceable. The battledoor, the football, bicycle riding, pitching quoits, and the athletic sports of the gymnasium, all have their appropriate place. The greater the variety the better, as by it all parts of the system are brought into play, and both the mind and the muscles get the change which they need.
It is hard to impress patients with the importance of this subject. Say what you will, they somehow or other get the idea that a moderate amount of exercise, taken when they feel like it, is all that is required. Fatal mistake! Whatever the physician may do, the patient has a great deal to do for himself. He must strive to develop his physical powers to the utmost. He must train himself as runners and fighters do when preparing for their surprising feats; for he is running against the swiftest disease (or the surest winner) of our climate, and fighting with the elements.
If he regards life as not worth this exertion, of course he will not make it; but 1 beg him to consider that without it recovery will be uncertain, and in many cases, impossible. Do as I have directed, and if your medical attendant is skilful, the current of health will, in many cases, begin to flow back to you. Life will renew to you its policy of insurance, and multiply your days.
Drugs. Tonics and bitters to help the appetite, iron, strychnine, quinine in very small doses as a tonic; of the heart supporters digitalis may be given when indicated and used carefully under the advice of a physician, cough sedatives of which, perhaps, the most useful is one which may now be obtained at all drug stores, is the Elixir of Terpin hydrate with heroin in the dose of a teaspoonful four or five times a day.
Traveling: Consumptive patients have generally been sent to a southern climate. But where the case involves dyspepsia and afflictions of the liver, low latitudes are generally unfriendly. Liver complaints are the bane of a southern climate, and a sallow complexion is the inheritance of a southerner.
Tubercular persons, chilled by our northern climate, are sometimes temporarily relieved by the warmer atmosphere of the south. But the relief is only temporary; for, having lost the power, as they imagine, to bear the frowns of our northern sky, they are dying, and will die anywhere unless they recover this power. And the way to retrieve a lost advantage over an enemy, is, not to retreat to a point where recovery will be harder, but to meet him at once. If the constitution cannot bear up against an enemy under the bracing of a northern atmosphere, it will be still harder to do so under the wilting of a southern.
After all, the objects aimed at should be change and traveling. The exercise involved, the constant exertion required in getting from place to place, the agreeable sensations produced by the motion of cars and steamboats, the ever varying change of sights and sounds, and the constantly increasing stock of one's ideas of men and things, these are what rally the constitution, and open anew the springs of life.
Especially should all journeys for health be taken, if possible, with an object in view. Let the consumptive start with the view of seeing the cave of Kentucky, the prairies of the West, the great lakes of the North, the falls of Niagara, the fortress of Quebec, the Saguenay river, the doctor, who he has reason to think will cure him, anything which he is willing to make exertion to see, and that he is sure his eyes will rejoice in beholding.
I have thus spoken of consumption more at large than of other complaints, because it is the great disease of the world, and is increasing with the advancement of civilization.
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